Iron Testing and Anemia Screening for Infants with Staffan Ahlandsberg, PhD

Katie Ferraro (0s):

Before we get started. I, have a quick baby Ezra update. So I've been following my own 100 First Foods daily meal plan. I'm making five new foods a week for my friend Carissa's baby Ezra. So we're on week six now and Ezra is moving into eating foods 26 to 30. So I can't believe it. We're more than a quarter of the way done. He's very slowly starting to be more interested in the foods. I'm beginning to get longer videos back from his mom as he's actually starting to eat, which is exciting. And hey, if your baby is not really taking to solid foods yet by six weeks after you started, please do not stress. It generally takes most babies anywhere between 8-12 weeks to really get the hang of starting solid foods. But here are the five new foods that Ezra is having this week.

Katie Ferraro (41s):

We're following my five step feeding framework. So we introduce one new food each day for five days each week. And each of those new foods comes from one of the five feeding categories. So on Monday, we do a new fruit. We're having pineapple, I mean these really cool little pineapple mini muffin loaves with no sugar and no salt. And, you cut em into little pieces. The baby can pick them up and eat them. Tuesday we're doing a new vegetable. It's cauliflower. One of my favorite recipes in our 100 First Foods daily meal plan is our curry cauliflower recipe. Wednesday we're doing a starchy food, so it's a kind of random whole grain called teff, but you make these really easy little teff burgers that turn into finger foods the baby can feed themselves. So good source of carbohydrate.

Katie Ferraro (1m 22s):

On Thursday we do a new protein food. We did ribs this week, which if you've never made a rack of ribs, we have the easiest way to do it. It makes this like fall off the bone meat that babies absolutely love. And then on Friday we do a new allergenic food that's tree nut. I'm a little bit nervous because he did have an allergic reaction to peanut, so they're kind of waiting to see if he's allergic to peanut, so that will kind of determine how we do tree nut. But if you want to follow that same 100 First Foods daily meal plan that we're doing, it's all part of my Baby-Led Weaning with Katie Ferraro program. I have the exact sequence of foods to feed as well as my 100 First Foods content library so you can learn how to prepare all of the foods on the 100 First Foods list. 'Cause I want your baby to eat 100 foods before turning one.

Katie Ferraro (2m 3s):

You can follow that exact meal plan and try all these new foods and recipes too when you sign up at babyledweaning.co/program. Again, that's babyledweaning.co/program and I hope to see you there.

Katie Ferraro (3m 22s):

Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby-led weaning. Here on the Baby-Led Weaning Made Easy podcast, I help you strip out all of the noise and nonsense about feeding, leaving you with a confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. When you go to your baby's pediatrician, do they ever do a finger stick or a heel stick test to check your baby's hemoglobin level? So hemoglobin is the oxygen-carrying part of your red blood cells and low hemoglobin levels can be a first glimpse into what may actually be iron-deficiency anemia.

Katie Ferraro (4m 3s):

Now we talk a lot about iron on the podcast because it's important to be including iron-rich foods in your baby's weaning diet. And iron-deficiency anemia- I don't wanna freak you guys out, I know you're concerned about it, but it is a major global health problem with according to 2019 statistics, it's thought that about 40% of the world's children age six months to five years have iron-deficiency anemia. And that's very bad news because of the very important role that iron plays on cognitive development. So, we want your baby to have adequate iron stores so that their brain and everything else in their body is developing appropriately. So in the United States, the American Academy of Pediatrics recommends screening for iron-deficiency anemia by 9-12 months of age. But every time we pull our audience on this topic, I am blown away by how few pediatricians are doing hemoglobin checks in the office.

Katie Ferraro (4m 48s):

It's a very safe, low cost effective way to screen for iron-deficiency anemia. Not to mention that it helps give parents peace of mind, right? When you see that hemoglobin level in a normal range, you're like, heck yeah. This variety of foods that I'm helping my baby learn how to eat, it's paying off, it's helping them establish adequate iron stores. So my guest today is Staffan Ahlandsberg. He has a PhD in life science and he's the director of marketing and communications for a company called HemoCue. He pronounces it "Heh-moCue", I think in the United States, we pronounce it "HeemoCue." It's neither here nor there. They make a diagnostic point of care testing device. And some of these you've probably seen in your own pediatrician's office. I know I first became interested borderline obsessed with the HemoCue when my pediatrician did a heel stick test in office at my oldest daughter's nine month well check.

Katie Ferraro (5m 35s):

I remember seeing hemoglobin testing devices in lots of different WIC offices that I had worked in earlier in my dietitian career 'cause they do hemoglobin screening in the WIC program. But after doing baby-led weaning with my next six kids, I was always very interested in whether or not like are my babies getting enough iron from the foods. And the hemoglobin heel stick was one of the things that I always looked forward to at our pediatrician appointment. So I've been dying to chat with a representative from HemoCue. I tracked him down at the National WIC Association meeting and I like cornered, the American sales gal, and I was like, please nobody will email me back. But I really, really, really wanna talk with a scientist from your company. So I wanted to learn more about hemoglobin checks and the technology. Staffan in this interview talks about how to get the best sampling technique if your doctor is doing hemoglobin testing via heel stick or finger stick in their office.

Katie Ferraro (6m 19s):

And then, so you guys know like what do you do if your doctor isn't screening for iron-deficiency anemia? Because that is important too. So if you are at all interested in iron levels in your baby, I think you'll really enjoy this conversation with Staffan Ahlandsberg from HemoCue.

Staffan Ahlandsberg (6m 37s):

Hi, thank you very much for having me, looking forward to this.

Katie Ferraro (6m 41s):

I am very excited to talk about iron and infants, but before we get started, could you tell us about your professional background and in particular the work that you do?

Staffan Ahlandsberg (6m 53s):

I have a PhD in biochemistry which ties nicely to the topic that we will talk a little bit more about, and I work at the company since 2015. And the company's name is HemoCue and we are working and developing medical devices with a aim to measure Hb indirectly, sort of iron supplements and how you go about that.

Katie Ferraro (7m 16s):

Okay, I have a question. I always called the company "HeemoCue", but you pronounce it "Heh-moCue".

Staffan Ahlandsberg (7m 22s):

We pronounce it "Heh-moCue". It's a, it's a mix between hemo- hemoglobin, and the cuvette, which is key to the test that we provide. So it's a mix between hemoglobin and the cuvette, but we perform the test.

Katie Ferraro (7m 36s):

I never knew that I, I got the hemo part but the cuvette I didn't know. So in the United States, the American Academy of Pediatrics here recommends that pediatricians screen for anemia between nine and 12 months, so I became familiarized with the HemoCue products because my own pediatrician, I have seven children, when we go to the doctor's office, they have an in-office device. They do a heel stick for checking the hemoglobin levels. So you mentioned that you work, you know with the Hb hemoglobin. Can you explain what that is, what it does in the body and then a little bit about how the HemoCue works.

Staffan Ahlandsberg (8m 16s):

The hemoglobin is a part of the red blood cell and the red blood cells are produced in the bone marrow. The work the red blood cells perform in the body is to carry oxygen to all the vital parts and the oxygen-carrying part of the red blood cells is called hemoglobin. So this is a cell that transports oxygen and the oxygen-carrying molecule within the red blood cells is the hemoglobin molecule.

Katie Ferraro (8m 48s):

That's a perfect explanation. And I think it's a bridge for parents when we're measuring the hemoglobin, it's not a direct measurement of iron, but it's a marker for iron status. Is that correct? And how, how does the hemoglobin tell you what's going on with the baby's iron status?

Staffan Ahlandsberg (9m 5s):

When you test your hemoglobin, you test for a condition that we call anemia. And anemia is a condition that develops when your blood produces a lower than normal amount of healthy red blood cells. That condition is called anemia. And you can test anemia by measuring the Hb level by taking a simple, like you said, heel stick or fingerprint or so on. So then you measure the level of normal amount of healthy red blood cells. The course why they are not, you know, healthy could be many different things. One is iron deficiency, which is then called iron-deficiency anemia, but it could be many, many different courses that triggers anemia.

Katie Ferraro (9m 51s):

Now for us in the United States, I think parents are fearful or worried about iron and they hear these messages like, oh my gosh, at six months your baby needs to start eating iron foods and they're not gonna get enough iron if they don't. And you know, we teach parents, listen, your baby has some iron stores that they got from the tail end of pregnancy from mom. They're getting iron from breast milk and/or formula. They're also learning how to eat iron foods. But I do know that iron deficiency is the most common micronutrient deficiency in children around the world. And you mentioned when we were chatting before, you know as we were trying to set up this interview, that you've also worked in global iron work, so I was just curious, how does screening for iron-deficiency anemia work in other countries, in developing countries or other countries where you've worked compared to the United States?

Staffan Ahlandsberg (10m 40s):

You're absolutely, you know, you spot on that it's important that you have that you measure and test for anemia and, and the prevalence of anemia is pretty high actually about, in young kids it's about 20% of kids that have anemia and about 25% are, you know, likely to have it somewhere during life, which we look in developing countries. But in developing countries like India where I worked a lot there, the numbers are, you know, much, much higher. We talk about 40 to 85% that have anemia. And it's interesting that you talk about the development of children because actually we try to think about the, what we call the 1000- day concept and it actually starts before the child is born because the mother who carries the the baby increase the blood volume just because of the pregnancy.

Staffan Ahlandsberg (11m 32s):

And if the red blood cell development doesn't co-follow this one, the mother is likely to become anemic, which is then carried over to the baby. And since anemia or oxygen transportation, if we put it like that, is vital for the development of all the functions in a baby. For instance, when they're born, the cognitive brain, the brain development, etc, etc. If these things, if you are anemic and born with anemia and it's not tested and treated for in due time, it is very likely that we'll have an impact on your cognitive development. And if you consider them that 50% in the population are born with that kind of disease and left untreated, then it's gonna have a socioeconomic impact all the way up until that because it will cause poverty.

Staffan Ahlandsberg (12m 23s):

It's not gonna be possible to, you know, work or go to school and learn at school and so on and so forth. So, it can have a tremendous impact if you're not observant on your anemia.

Katie Ferraro (12m 36s):

And Staffan, you mentioned the cognitive development. So with anemia, iron-deficiency anemia, we see delays in a child's cognitive development, but in what other ways can suboptimal iron levels negatively impact a child's health?

Staffan Ahlandsberg (12m 51s):

So with anemia, you are much more prone to get infectious diseases. For instance, if you live in a part of the world where for instance malaria is, you're likely to get the there like in India where I was. And I met the doctor there that said that there are malaria, it's not the cause of the death, it's actually the anemia that is developed due to the malaria that causes the death. So I think that for me at least was an eyeopener, that there are differences around the globe and the secondary impact in this case than India has vital outcome on people's life and can have a tremendous impact on that.

Staffan Ahlandsberg (13m 35s):

And I think if we compare, let's say we compare US with with India in this case there are, for me there are, there are one major difference. One is that in US you have healthcare centers that people go to and get tested and healthcare is available if, if we generalize, it is readily available for people to go to healthcare center. There are public health programs like the WIC program that also have a part of where people can go and get tested during under public healthcare programs. In other parts of the world, healthcare is not that easily available. So in many parts of the world the healthcare needs to go to rural settings and this is a huge difference that you have big, big programs, public health programs that are privately funded in many cases where people like ASHA workers in India go to rural villages and test women and children this way.

Staffan Ahlandsberg (14m 34s):

So healthcare goes to the women and children as the other way around. And I think this is a, this is to some extent a, a difference between the different possibilities to get this testing done and treat development of anemia.

Katie Ferraro (16m 0s):

You know, it reminds me, I know you did a lot of work in India. After college, I was a volunteer in the country of Nepal for two and a half years. So just north of India, and I worked in maternal and child health and we worked in rural health settings. And I worked at the health post and it was so interesting because they didn't have prenatal vitamins but they had iron pills and so they would tear off pieces of newspaper, they would count out 30 pills or however many days in the month they would wrap it up. And having those iron pills for the pregnant moms was like one of the most important parts of the prenatal experience because of course the diet is very high in carbohydrate, very low in iron and protein. It's not a very iron-rich diet, almost no animal foods, a little bit of plant protein and iron from there, but as we know, not as well absorbed by the body.

Katie Ferraro (16m 45s):

And I remember the women just like clutching onto those iron pills for dear life and a lot of our messaging was like very simplistic about the importance of iron in pregnancy and then obviously promotion of breastfeeding etc, to try to promote, you know, iron that way in the infant. So I appreciate the work that you have done in the global scenario and looking back at the United States, that's where my audience is when we talk to parents like on social media and we ask about, you know, is your pediatrician screening for anemia? I'm really surprised how many doctors are not talking about hemoglobin screening or anemia screening for infants. And again, we don't wanna stress the parents out, but do you have any statistics like what percent of infants are getting screened in their doctor's offices?

Katie Ferraro (17m 30s):

Which you know, it is a national protocol yet we find a lot of parents are totally clueless and their doctors never even talk to them about iron.

Staffan Ahlandsberg (17m 37s):

To be honest, I don't have a number how many that are not, that are not tested. The only numbers that we are aware about, those are the ones that publish either by the American Association of Pediatricians or the WHO and in US again here looking at surveillance numbers within that age category it is about 20% but it doesn't tell how many people that are, how many kids that are tested.

Katie Ferraro (18m 6s):

Good point.

Staffan Ahlandsberg (18m 6s):

So we don't know. The guidelines suggest once every year up until the age of, I think it is five. Don't take the that number for exact, but I mean that's the guideline that's, that comes to my mind that they should do this if they follow the guidelines or not. It's very, very difficult for us to know where to dig out and the numbers of that in US. I visited a primary care health center, I mean but super interesting. I think there's a big difference there between different physicians also at the same healthcare center because the funny thing with this center was it was two physicians and one was on an average doing 10 Hb tests per day and the others were doing one.

Staffan Ahlandsberg (18m 48s):

So why is that? That's super interesting to understand, you know, why is this such a big difference between two physicians working in the same primary care center? You should think that you know, they come across similar diseases or similar patient groups, etc, etc, but they at least this specific center and this specific setup, they they took the test very differently. Yeah, two different, one was taking 10 tests a day and the other is one. So why is that? It's difficult to know.

Katie Ferraro (19m 18s):

I don't know but I loved when we would go to the doctor, I have seven little kids, and I have two sets of multiples. I have a set of quadruplets and a set of twins. So in three years we had seven kids like I was at the pediatrician all the time. And I teach infant feeding, we don't do rice cereals, we teach them how to eat iron-containing foods. But in the back of your mind you're always a little nervous. Oh my gosh, what if they're not getting enough iron? I loved when my pediatrician would do the hemoglobin test because when it came back within normal limits, it was a peace of mind for me as the mom when I left that office. I am doing a good job, they are getting enough iron even though they're not eating whole pieces of meat yet.

Katie Ferraro (19m 58s):

We're doing okay and I wish more doctors would do it to help validate the parents you're doing the right thing and then if you're missing the iron it's not, I know it's not like diagnostic of a of iron-deficiency anemia. If you have a low hemoglobin, we'll we'll talk about what you do next if the hemoglobin value comes back low, but I wish more doctors would do it because it is that like objective validation to the parents. You are doing a good job otherwise they're just guessing you, you can't see, I mean I know there are symptomatic diagnoses for iron-deficiency anemia, but like if the hemoglobins all, you can't see it unless the doctor tells you.

Staffan Ahlandsberg (20m 29s):

Exactly. To your point, and I think the word, the word that I like a lot there is like you say, peace of mind because it's peace of mind for the parent and it's also peace of mind for the kids because they know they do good job and this is the way to sort of behave or live a life. And also, I mean the physicians should also feel peace of mind because you know they are healthy because anemia is a really good guidance on general health. It it just goes like that. It's, yeah, if your Hb level is is okay, generally you're not fatigued, you're not tired in general then there are other conditions of course it could be under conditions but in general it's a very good health marker.

Katie Ferraro (21m 9s):

As I understand it from talking to representatives from your company, and I just in my own personal interest, like I'm the mom and the doctor that like for one of my youngest twins, her hemoglobin came back slightly below optimal levels at her 12-month checkup. I asked them to retake it, I asked them to retake it again. On the third time, pushing the third or fourth drop of blood out it tested normal and I remember thinking okay and then another time it came back low and it really was low and we had to work on different iron foods. But could you just tell us like general best practices if you're in an office and the doctor has a HemoCue and they're testing for hemoglobin, like obviously it would need to be calibrated. I think I remember hearing that you don't do the first drop of blood, it's supposed to be the second one.

Katie Ferraro (21m 52s):

Like are there just some best practices for getting the most accurate results from this test in your pediatrician's office?

Staffan Ahlandsberg (21m 60s):

Yes it is and we call this the three analytical factors and that is the way you take the capillary sample when you use these devices. So if you have poor sampling technique then you can have a misreading but rarely depending on what kinda device they pick up here because there are numbers of different point-of-care Hb testing devices there, but, but if you use one of the, you know, then they most often they read accurate but it's the capillary sampling technique that is vital to get a good reading or a correct reading I should say. That is your, so you should not be cold and you should massage the finger and you should say the finger prick at the, you know, in a, in a correct way and then you should make sure to fill the cuvette in this case properly and it's just a drop of blood, it's 10 microliters so it's not, you know, it's not a lot of blood, it's just a drop of blood.

Staffan Ahlandsberg (22m 54s):

But if you do this sample technique in the correct way then you, you will most likely get a accurate really.

Katie Ferraro (23m 1s):

Sorry, did you say they should not be cold?

Staffan Ahlandsberg (23m 3s):

Yeah, so I mean you should have a good blood circulation because if you have-

Katie Ferraro (23m 7s):

But have you ever been in a doctor's office like they blast those places with the air conditioning and the babies are freezing.

Staffan Ahlandsberg (23m 13s):

So that's why sometimes you massage the finger a little bit to get the good blood circulation because if you have poor circulation, obviously your skin get pale. You have noticed that probably on your hands and pale skin color is in some countries actually used to diagnose anemia. So you can make that connection. You should have a good circulation and you can do that by, by sourcing the the finger that you ought to prick.

Katie Ferraro (23m 42s):

How come some pediatricians do finger stick and some do heel stick? Is one better than the other or preferred or what's the reasoning there?

Staffan Ahlandsberg (23m 51s):

The general guidelines is here actually to not make heel sticks when they can walk.

Katie Ferraro (23m 55s):

Because it would hurt after or what?

Staffan Ahlandsberg (23m 57s):

Yeah exactly because it impacts, you know it can impact then you can do it on the fingers. But if they are really, really small it's more or less impossible to get a good blood supply from these tiny fingers, then the heel is much more suitable for that, for that reason in general I think you do heel stick between up to up to nine months, but after that in general you do fingers stick but it could, there are variations to this.

Katie Ferraro (24m 25s):

Okay. But one is not significantly more accurate. I mean your blood is your blood, right?

Staffan Ahlandsberg (24m 30s):

No, no, they're equally accurate as long as you do have a good sampling technique but some are afraid of making a proper finger prick so you don't get enough blood out, then you will get poor reading because of the sampling technique. Here again, this is what we call pre-analytical factors and irrespective of devices or you, you use, this is of essence that you have a good pre-analytical technique.

Katie Ferraro (24m 54s):

I was so surprised when I started looking into the devices that they're not very expensive. Like when some offices don't have them, you're like, in some cases this is a $300 device. But then I'm also blown away that some parents are telling me, oh my doctor doesn't have hemoglobin testing in the office. They do a straight up IV blood draw to check for iron levels and hemoglobin. To me that feels not necessary. I understand that, that you need to go have an IV blood draw to confirm the diagnosis of iron-deficiency anemia. But for the first round of screening, why do some doctors jump right to a very invasive blood draw on an infant if they could just be doing hemoglobin screening.

Staffan Ahlandsberg (25m 29s):

This is a very interesting topic to discuss if you are in the business where I come from, which is point of care testing where you would like to get the essential diagnostics as close as possible to the patient. Like you say, why don't you do it in the physician's office? So in some instances there is a lab in the back door somewhere where they send all the samples. So they prefer to make like you say, a venous draw and then send over along to get all different parameters at the same in in one go. The flip side of that is that you have to wait for the result, etc, etc. So you don't get that immediate feedback when sitting with the physician and you don't get that peace of mind that you were talking about earlier on when you're in there.

Staffan Ahlandsberg (26m 11s):

But they get the broader panel and can shake for many more parameters as compared to use one of these point of care devices. But if you're used there for, you know, a general health checkup, I don't know exactly what to say, you know, I, we call it essential diagnostics like your diabetes, your Hb testing for instance and so on. HbA1C is one of these markers that you probably heard a lot about. Also, it's not related to this topic at all, which we discussed now, but there are a few here which is, you know, very much for point of care testing.

Katie Ferraro (27m 57s):

And so what do you advise pediatricians if the hemoglobin with the perfect sampling technique comes back low? Obviously it's unique to each child. There's many different reasons, but then you know, I as the mom, I'm the most annoying patient. I would always ask them to retest and retest because sometimes it would come back normal then and I said, you know, if I didn't ask for that I would've left this office feeling so bad. But on occasion one of my own children, the hemoglobin was at 11. The doctor doesn't like that. Okay, what do you suggest then falling that from a diagnostic standpoint? Do you walk out of the office? You can't say that child doesn't have iron-deficiency anemia. What do we do next?

Staffan Ahlandsberg (28m 29s):

So I mean, first of all, if it is anemic, you know, I, I wouldn't ask for three or four tests because it's just the nature of the game of all these devices that there is a span and there is a limit and there is a calculation. So they are correct and accurate, but if you do multiple tests for the same at the same person at the same time, it'll vary. It will vary. That's just the nature of all these tests. So, I wouldn't ask to do consecutive tests used to get the, you know, now I'm, I have no anemia so then I'm happy. I wouldn't do that. I would, I would trust the first one then you need to think of, you know, what could be the course of this. Most often you, you, you start out by iron supplement or nutrition suit, especially if you are in the US.

Staffan Ahlandsberg (29m 13s):

There is also another part of this, which is the general medical exam where you talk about what could have happened and not happened and try to relate to this. But if you don't know then you need to examine further and then you need to make this venous blood draw and send off to a lab to investigate what type of anemia is this really. Most often in Sweden, in US and so on the medical exam and the discussion with the patient mother and child most often guides to very good first line of treatment, I would like to say being iron deficiency or related things actually.

Katie Ferraro (29m 52s):

Globally, how does the US stack up as far as like this screening goes compared to other countries that you work with? You're a global company, you obviously see a lot of different countries in the way they do this. If we're talking about babies six to 12 months of age.

Staffan Ahlandsberg (30m 6s):

I mean as most of the developed countries they stack up very, very good. We think, you know, being a provider of these devices, of course this comes with the responsibility. And I think the responsibility are is a multi-stakeholder game here because the testing needs to be of course robust and you have all, you get the right reading, but it needs to be affordable, accessible and available. Logistics comes into play here. And I think in developed countries, logistics and supply and training and ease of use and the skills to do the perform the tests is very well, you know, established and it works fine. There are those challenges you see that that kinda challenges is elsewhere in the world as comparing US.

Staffan Ahlandsberg (30m 51s):

So, I think it's very well. Then it's more like there might be like an educational problem because you can also test when you, when you score anemia you can see differences in in socioeconomic groups within one country or in certain regions and so on and so forth. And there maybe you can find differences within us.

Katie Ferraro (31m 11s):

Is there anything else that you think is important for our audience? These are primarily parents and caregivers of babies who are six to 12 months of age. What should they know about iron levels or hemoglobin or screening for iron-deficiency anemia in that prior to 12 months of age stage?

Staffan Ahlandsberg (31m 28s):

You should ask for the test. If they don't take it on a regular basis, you should do the test at least once a year. And I think also you should think also before the baby's born to make sure that the, the carrying mother is also, you know, coping with her Hb levels because it's also sets the foundation for the child. I would extend that to what's called the 1000 days concept up until the age of two years old. I think it's of essence to have the anemia or the Hb level checked for so you can make adjustment to your nutritions or something like that, like breastfeeding and things like you already mentioned before that then I would use like to add to to, I think women and children is most important and, and not forget adolescents, girls, it's super important when they have start to have the first menstruation, bleedings and stuff like that.

Staffan Ahlandsberg (32m 30s):

And when they are developing to, to have really good control of anemia levels and in that age also I got two daughters in that age then food can be a very delicate matter to discuss for many different reasons. But if you start to become anemic and fatigued at that age due to menstruation, bleedings or food intake and so on, it'll definitely have an impact on school. Your social networking and just being able to cope with friends and life and can have an dramatic impact.

Staffan Ahlandsberg (33m 15s):

There are actually publications out now that points to depression and anxiety is related to anemia. So there are periods in life not only for infants but also later on where anemia is maybe more important to have under control as compared to others. Also for people who practice and train a lot.

Katie Ferraro (33m 33s):

You're right, it's a, it's very important reminder. We get so fixated on iron for infancy, but it's like this extends into life. And, I think any adult who's experienced iron-deficiency anemia, they always say like, you didn't realize how fatigued and exhausted you were until you started treating it. And they're like, oh my gosh, I remember one pregnancy, I had a lot of bleeding with my twins and they gave you IV iron in the hospital. I mean I felt like superwoman. I was like this is what's been missing in my whole life. I'm apparently extremely fatigued but, but it isn't something that just turns off at the age of one and I think a lot of times as parents, once we get over the hump and our babies learn how to eat and we're more confident, we sometimes let our guard down with regards to the quality of the foods that they're eating.

Katie Ferraro (34m 15s):

And if it's a highly refined processed diet, what we call the standard American diet and there are not iron-rich foods in it and there are minimal intakes of fruits and vegetables, so you're not getting the vitamin C to help with the iron absorption. You see how easily it can be to kind of fall into a dietary pattern, the typical kid's diet where they're increasing the risk for iron deficiency. So that's a good reminder that this is a, a lifespan wide condition. It's smart to focus on and learn about in infancy but keep it up throughout childhood and adolescence and even as adults, a lot of very fatigued moms are listening to this who may be iron deficient as well.

Staffan Ahlandsberg (34m 54s):

And do not forget the grandmothers and grandparents because elderly also get anemia and they are much more prone to infectious diseases and the outcome of infectious diseases can be much severe for elderly people of course. And if they get not the proper diet at elderly care centers or whatever and loss of appetites and stuff like that, it's more likely that they become anemic and then more prone to get infections and those are more severe.

Staffan Ahlandsberg (36m 27s):

So it is really something that comes through life.

Katie Ferraro (36m 29s):

In the United States, you know you talked a little bit about healthcare and access and affordability. And I do a lot of work with the WIC program, our special supplemental nutrition program for Women Infants and Children. And so for those of you listening who may not be familiar with it, it's a US government nutrition assistance program and so a lot of times I'm working on the food side teaching them how to make the food safe. But we also know that for many of these families it's really their only healthcare. This is the catchment net for healthcare for screening and one of the best things that WIC does is they provide benefits based on what they call nutrition risk. And one of the way they assess nutrition risk is through hemoglobin checks.

Katie Ferraro (37m 11s):

What do you know about the role of hemoglobin checking or screening in the WIC program? I think I've seen in many WIC offices that I've been in, I've seen HemoCues there, so I was just curious having, you know, the global background that you do. Any thoughts about our WIC program, good, bad or otherwise with regards to the work that they're doing?

Staffan Ahlandsberg (37m 30s):

I think the WIC program is just, is is an excellent case of you know, how healthcare can be brought to people that really needs it and might not have the possibility to get access to it at least as many others. We're just glad that we have the possibility to be a part of that and make it accessible because I think access to, like in this case, essential diagnostics done by the WIC program is absolutely fantastic and it's, it's just great to see that and I'm glad that's-

Katie Ferraro (37m 59s):

Because all of our WIC moms, our WIC moms always know like, oh I know what my baby's hemoglobin is and then moms that are not in WIC are sometimes like what are you talking about. My doctors never even screened for that. So I think it's an area that the WIC program and there's a lot of work to be done certainly on the food and the nutrition side, but I think it's wonderful that we're addressing and assessing nutrition risk. Like that's what we're supposed to do. You can't make an intervention if you don't understand the risk factors or you know what the plan of care is and knowing whether or not there's a risk for iron-deficiency really kind of helps set the course for, like you said, many important things. This isn't just a temporary thing, this is cognitive development of your children.

Staffan Ahlandsberg (38m 37s):

I agree that's it has an impact. Definitely.

Katie Ferraro (38m 38s):

People listening Staffan who wanna learn more about hemoglobin screaming about HemoCue, where's a good place to go to start doing a little bit of research before they maybe go to their doctor and be like, hey, why aren't you testing my baby's hemoglobin?

Staffan Ahlandsberg (38m 49s):

With this audience? You know, I would suggest of course you can go to one of the company's websites that provides these Hb tests that there, you can read a little bit about it, but otherwise I think the WHO is just a fantastic homepage to read about anemia. Anemia impacts in both developed and developing countries prevalence and all sorts of aspects of of anemia. If you think more about women and children, I would say that the 1000 Days, there is an organization called 1000 Days used to also have very, very interesting and very good reading about anemia nutrition, malnutrition, iron deficiency, breastfeeding and everything related to infants and the 1000 days concepts basically.

Katie Ferraro (39m 38s):

Well I will link all of those resources for our audience in the shownotes for this episode and thank you so much for a very interesting conversation. I know this is a little bit of a different audience than you're used to. I think I was telling you I've tried for like a year to get this interview. So I really appreciate getting on the calendar, having the chat because I think it just helps raise awareness and we want our parents to be, you know, good stewards of health but advocates for their children's health as well. And, and knowing the right questions to ask sometimes is, is the first step in helping improve your child's overall health with regards to their healthcare.

Staffan Ahlandsberg (40m 12s):

Thank you very much for having me here. Thanks.

Katie Ferraro (40m 14s):

Well, I hope you guys enjoyed that interview with Staffan Ahlandsberg from HemoCue. I will put all of the resources related to what we talked about for iron testing and hemoglobin checks and anemia screening for infants, all in the shownotes for this episode, which you can find at BLW podcast.com/ 374. And a special thank you to our partners at AirWave Media. If you guys like podcasts that feature food and science and using your brain, check out some of the other podcasts from AirWave Media. We're online at BLWpodcast.com. Thanks so much for listening and I'll see you next time. Bye. Now if you're interested in doing baby-led weaning, but you're not exactly sure, like what does that mean?

Katie Ferraro (40m 58s):

What does it look like? Where do I start? My online program called Baby-Led Weaning with Katie Ferraro has everything you need to give your baby a safe start to solid foods and get them to eat over a hundred foods before they turn one, whether you're terrified of choking or maybe you've started but you feel like you're feeding your baby the same foods over and over 'cause you don't know what to feed next or you're looking for guidance on how to prepare foods safely for your baby's age and stage. My program has exactly what you need. There's five hours of concise self-paced video training. You can knock this thing out during nap time this week. You also get access to my hundred first foods content library so you can see and learn exactly how to prep all of the hundred foods as well as my original 100 days meal plan. I've been refining this program for the last seven years.

Katie Ferraro (41m 39s):

Just today, a mom wrote to me and told me that the a hundred days meal plan has been a "game changer" for her busy lifestyle. When you join the program, you also get access to over 100 phase two combination food recipes. So you're gonna try out the trickier textures, push your baby's palate, and what's cool about these recipes is your whole family will enjoy them. So everything you need to give your baby a safe start to solid foods is inside of the program. It's created by me, a registered dietitian who specializes in infant feeding. If you're tired of hunting and pecking around the internet trying to piece this stuff together on your own, I put it all in one convenient place for you. I invite you to check out the Baby-Led Weaning with Katie Ferraro program that's at babyledweaning.co. Again, that website is babyledweaning co. and click on program to learn more.